Clothing Purchase Decisions and Social Participation: An Empirical Investigation of U.S. and U.K. Rehabilitation Clients

Article excerpt

Survey findings on clothing decision making and social participation of U.S. and U.K. rehabilitation clients and the role of clothing in the rehabilitation process of persons with disabilities are discussed. Eight clothing purchase decision variables (CPDV) were rated and ranked according to their importance. Tukey's multiple comparison results confirmed a complex clothing purchase decision-making process for both U.S. and U.K. clients, while ANOVA results indicated a cultural influence on CPDV. Pearson correlation coefficients suggested some empirical relationships between 7 CPDV and the level of participation in 10 social activities. Policy implications of these findings and the role of clothing in the rehabilitation process are presented.

Clothing and socialization represent unique and important factors in the rehabilitation of persons with disabilities. The goal of rehabilitation is to maximize a client's potential by restoring persons with disabilities to the highest physical, emotional, social, and economic level (Bricker, 1958), and clothing can play an important part in this process. It can enable persons with disabilities to be more successful in their rehabilitation by helping establish a positive self-image (Newton, 1976), and facilitating communication during social interaction (Roach-Higgins & Eicher, 1992).

The role of clothing in the socialization of persons with disabilities needs to be emphasized because clothing can help in the socialization phase of their rehabilitation (Yep & Yep, 1976) and leisure activities, which are social in nature, can be used to improve the quality of life of persons with disabilities (Beck-Ford & Fox-Smith, 1986). The philosophy of normalization (Wolfensberger, 1972), suggests that persons with disabilities be integrated physically and socially with their peers who are not disabled (Schleien & Ray, 1988). Since appearance is what is presented to others in social situations (Lamb, 1991), normative dress may enhance social participation (Kaiser, Freeman, & Wingate 1985). Appropriate appearance can lead to a positive self-image and greater integration into society during work and social activities (Guthrie, 1992). For many persons with disabilities, participation in leisure pursuits may produce a higher performance level in a variety of activities leading to a more positive self-concept, a gain in social skills, and acceptance by other members of society (Bender, Brannan, & Verhoven, 1984). The physical and functional aspects of integration, however, may be achieved more readily than social integration as suggested by a study of deinstitutionalization in Sweden (Pedlar, 1990).

A great deal has been written on the effects of physical attractiveness, i.e., the body, on person perception and social interaction (Berscheid & Walster, 1974; Hatfield & Sprecher, 1986). Positive responses are generated if a person is perceived to be physically attractive, while negative responses are generated if a person is perceived as physically unattractive. Bardock and McAndrew (1985) found that physically attractive and appropriately dressed individuals were more likely to be hired than unattractive and inappropriately dressed individuals, while Lennon (1990) found that individuals who were attractively dressed were judged to be more competent, sociable, and more desirable to work with than those who were unattractively dressed. Appropriate dress was found to affect the decision to hire a person with a physical disability (Ray, 1986). This suggests that clothing selection and coordination may be variables that can be controlled and used as self-determination tools to elicit positive responses in work and social situations for individuals with a disability.

Early contributions in the area of clothing for people with disabilities in the United States (U.S.) were made by occupational and physical therapists (Hallenbeck, 1966) in their analyses of the functional aspects of dress. The focus on clothing that was both functional and fashionable for individuals with disabilities began in the mid-1950s by Cookman and Zimmerman (1961). Many of the ideas generated by their research are still in use today; however, the designs were not widely adopted at the time because the social, political, and economic climate was not ready to explore this level of need. In the U.S., various pieces of legislation, including the 1973 Rehabilitation Act, the 1990 Americans with Disabilities Act (ADA), and the 1992 Reauthorization of the Rehabilitation Act, have set the stage for the rehabilitation community to include the issue of full integration of individuals with disabilities within the framework of rehabilitation. More individuals with disabilities will find their way into the workforce and community as a result of the ADA and appearance can support that endeavor.

The importance of clothing to enhance a person's self-esteem, independence, and participation in social activities including appropriate dress for work, long has been recognized in the United Kingdom (U.K.) (Guthrie, 1992). By 1988, 20 clothing workshops were available in the U.K. which provided clothing advice as well as specially made or adapted clothing. The goal of these workshops was to contribute to the quality of life for people with disabilities by increasing self-esteem through enhanced appearance, managing impression formation at work or leisure through appropriate appearance, and increasing independence in practical and psychological ways. A descriptive study of clothing workshops in the U.K. was undertaken following a debate in the House of Commons in 1990 which focused on the need many people with disabilities have for special clothing (Guthrie, 1992). Only four viable clothing workshops remained at the end of the study because of pressure to decrease welfare services in the U.K. during the 1980s.

Clothing acquisition is a complex process as many factors enter into decision making. Figure 1 illustrates a framework for clothing purchase decision making. Price, appearance, and care are the primary factors affecting clothing purchase decisions. Price issues involve the actual cost of the item weighed against the benefit of the item to the consumer over time. Care factors related to clothing purchase decisions are ease of care and performance. Ease of care relates to the amount of time, energy, and cost required for garment upkeep, while performance relates to the expectation of how well the clothing item will perform over the life of the garment.

Appearance factors include the body (Hillestad, 1980) and all aspects of dress and adornment. Variables relating to the body encompass differences in: body forms, including body size, shape, and deviations from the norm; body expressions, including skin color, hair color and texture, and eye color and shape, etc.; and body motions, including gait, use of limbs, and use of assistive devices, etc. Dress is the most complex factor, encompassing functional and symbolic values (Rosenblad-Wallin, 1985) as well as aesthetic values. The functional value of dress includes: protection from the elements, falls, etc.; comfort related to garment structure and fabric composition; and independence in dressing. The aesthetic value of dress includes: color relative to personal preferences, coloring, and wardrobe needs; style including design lines and silhouette; fabric and trim including texture and weight; fit relative to the person's body and current standards; and quality relative to fabric and garment construction. The symbolic value of dress includes: expressing one's beliefs and values; enhancing a person's feeling of self-esteem and self-worth; indicating one's adherence to fashion; indicating group affiliation including work related uniforms and peer influence; and serving its a barometer of one's status or rank as symbols of respectability.

The primary purposes of this study were: (1) to examine the importance of clothing purchase decision variables (CPDV); and (2) to explore the relationship between clothing and socialization. Specifically, we attempted to validate this relationship indirectly by empirically measuring the level of association between the level of importance that rehabilitation clients placed on clothing acquisition decision variables and their level of participation in different social activities. A framework for clothing purchase decision making was developed and the following eight selected clothing purchase decision variables were utilized in the study: (1) physical comfort, (2) freedom of movement, (3) price, (4) ease of dressing, (5) psychological comfort, (6) fashion, (7) care, and (8) fitting in with group.




Participants in the study came from randomly selected states in the U.S. and from a single source in the U.K. In the U.S., a total of 1,730 questionnaires were sent to and distributed by 18 state Vocational Rehabilitation agencies randomly selected from each of the 10 regions of the United States Department of Education, Office of Special Education and Rehabilitation. Participating states disseminated the questionnaire by: 1) having counselors hand out questionnaires and returning completed surveys to a central point, 2) sending questionnaires to clients in a group setting and returning completed surveys to the researchers; or 3) sending questionnaires with a cover letter to individual clients, requesting participation and return of the completed instrument. A return rate of 36% was achieved with 625 questionnaires returned by clients from the 18 states over a four-month period. In the U.K., two-hundred questionnaires were sent to the Western Wiltshire Disabled Living Center, St. Georges Hospital, Semington, Wiltshire, England. The first approach for

questionnaire dissemination was utilized in the U.K. Over a four-month period, 99 clients responded to the questionnaires resulting in a 49.5% return rate. The U.S. sample was made up of people who were receiving vocational rehabilitation training and/or evaluation or who had received such services, while the U.K. sample was comprised of individuals who had used or contacted the clothing unit of the Western Wiltshire Disabled Living Center. Access to only one site in the U.K. may limit the findings of this study.

Selected demographic variables are presented in Table 1. An almost equal proportion of males and females were represented by both the U.S. and U.K. samples. While the majority of U.S. clients were in the 25-to-44 age group, the majority of U.K. clients were in the 45-and-over age group. The majority of U.S. clients and all of the U.K. clients were white. A higher percentage of married people participated in the study in the U.K. than in the U.S. In addition, more people were unemployed in the U.K. than in the U.S. A broader income span was reported by U.S. clients, while U.K. clients reported incomes in the lower brackets. Clothing expenditures were reported to be higher in the U.K. than in the U.S. More of the U.S. respondents reported moderate functional limitations than their U.K. counterparts. Many of the clients used a wheelchair.


A survey instrument based in part on a questionnaire developed by Wingate, Kaiser, and Freeman (1985) was utilized. Changes to the questionnaire were noted for U.K. participants where clarification was needed because of language or monetary differences. Data presented here included clothing selection and purchasing practices, social participation levels, and demographic information. Apparel acquisition purchasing practices and barriers to shopping also were examined in the broader study (MacDonald, Majumder, & Bua-Iam, 1994).

Research Objectives. The research objectives were used to determine: (1) the importance of selected variables on clothing purchase decisions, and (2) the level of participation in social activities relative to the CPDV by U.S. and U.K. rehabilitation clients. Respondents were asked to rate selected CPDV using a Likert-type scale ranging from 1 to 8, where 1 was "the least important" and 8 was "the most important". Included were the following variables related to clothing purchase decisions: (1) physical comfort; (2) freedom of movement; (3) price; (4) ease of dressing; (5) psychological comfort; (6) fashion; (7) care; and (8) fitting in with group.

In order to determine respondents' level of social activity they were asked how often they participated in the following: eating out, going to a movie, attending spectator sports, participating in sports, going to the theater or ballet, going shopping, playing bingo, playing cards, attending church services, attending church social activities, attending social club meetings, and going dancing. Level of participation was measured on a Likert-type scale ranging from 1 to 5, where 1 was "never" and 5 was "very often". These 12 social activities were measured against the CPDV.

Validity and reliability. Measures were undertaken to obtain content validity. Prior to instrument construction, questionnaires developed by Wingate et al. (1985) and Reich and Shannon (1980) were analyzed for content and format. A scale to evaluate the importance of the CPDV was adapted from one used by Wingate et al. (1985). Following questionnaire development, experts from textiles and clothing, therapeutic recreation, rehabilitation, and psychology reviewed the questionnaire to determine if it represented an adequate sample of the domain it was intended to represent and to evaluate format clarity.

The split-half procedure was used to check on internal consistency of the instrument. This generated correlation coefficients for the U.S. sample ranging from .67 for the social participation section to .65 for the CPDV section. Correlation coefficients for the U.K. sample ranged from .84 for the social participation section to .57 for the CPDV section. Reliability coefficients, calculated using the Spearman-Brown formula, ranged from .80 for the U.S. and .84 for the U.K. for the social participation section and .79 for the U.S. and .73 for the U.K. for the CPDV section. Thus, the survey instrument utilized in this research appeared to be appropriate, meaningful, and useful for specific inferences.

Data Analysis

Mean ratings of CPDV were generated in order to determine their relative influence on U.S. and U.K. rehabilitation clients. Univariate analyses of variance (ANOVA) (S A S, 1985) were used to determine the cultural impact on CPDV. Tukey's multiple-comparis on procedure (SAS, 1985) was utilized to determine the intra- and inter-cultural statistical differences between the mean ratings of CPDV. Correlation analyses were carried out to determine the bivariate relations between CPDV and the level of participation in 12 types of social activities by U.S. and U.K. rehabilitation clients.


Mean ratings of the importance of decision variables involved in purchasing clothing indicated some similarities and dissimilarities between the two cultures. A simplified model of clothing purchase decision making represents the ranking of these CPDV for U.S. and U.K. clients. For both groups, the highest rated CPDV was physical comfort (U.S. clients, M = 6.12, SD = 1.95; U.K. clients, M = 6.15, SD = 1.90). The second most important CPDV was freedom of movement (M = 5.43, SD = 2.07) for U.S. clients and price (M = 5.52, SD = 2.18) for U.K. clients. For U.S. clients, price (M = 4.86, SD = 2.31) was the third most important decision variable while U.K. clients selected care (M = 4.90, SD = 1.79). Ease of dressing (U.S. clients, M = 4.71, SD = 2.29; U.K. clients, M = 4.50, SD = 2.60), psychological comfort (U.S. clients, M = 4.56, SD = 2.33; U.K. clients, M = 4.19, SD = 1.96), and fashion (U.S. clients, M = 4.56, SD = 2.35; U.K. clients, M = 3.98, SD = 2.43) were rated by clients from both countries as the fourth, fifth, and sixth most important CPDV, respectively. The seventh most important CPDV was care (M = 3.88, SD = 2.15) for U.S. clients and freedom of movement (M = 3.74, SD = 1.95) for U.K. clients. Fitting in with group was the least important CPDV for both U.S. (M = 3.82, SD = 2.59) and U.K. (M = 3.36, SD = 2.18) clients.

The ANOVA results indicated statistical differences in the mean ratings of freedom of movement, F(1,661) = 55.57, p., price, F(1,662) = 6.81, p., fashion, F(1,650) = 4.86, p., and care, F(1,660) = 19.06, p., between U.S. and U.K. clients. Cross-cultural differences between the mean ratings of these four CPDV were confirmed by Tukey's studentized range test at p.

Results of Tukey's multiple-comparison tests provided additional insight into the intra-cultural differences of the mean ratings of CPDV. To U.S. clients, physical comfort and freedom of movement were rated the most and second most important decision variables, respectively. Their mean ratings were statistically different from other CPDV at p. Tukey's tests found no statistical differences (p.) between the mean ratings of: (1) price, ease of dressing, psychological comfort, and fashion; and (2) care and fitting in with group. For U.K. clients, Tukey's results indicated no statistical differences (p.) between the mean ratings of: (1) physical comfort, price, and care; and (2) ease of dressing, psychological comfort, fashion, freedom of movement, and fitting in with group.

A great variation in direction (i.e., positive or negative), scope (i.e., number of bivariate relationships), and intensity (i.e., r ranging from small to moderate in size) of the Pearson correlation coefficients between the level of participation in social activities and CPDV existed for both U.S. and U.K. clients. At p., the correlation analyses indicated some degree of association between 7 CPDV and the level of participation by U.S. and U.K. clients in 10 social activities. For U.S. clients, the correlation analyses suggested that physical comfort was negatively correlated with going shopping, (r = -.11), attending church social activities (r = -.12), and attending social club meetings (r = -.14). Freedom of movement was negatively related to going shopping (r = -.15). Price was negatively associated with attending spectator sports (r = -.12) and positively associated with attending church services (r = .12). Ease of dressing was negatively related to eating out (r = -.13), going to a movie (r = -.20), attending spectator sports (r = -.13), participating in sports (r = -.16), going to the theater (r = -.12), and going shopping (r = -.19). Fashion was positively related to eating out (r = .24), going to a movie (r = .13), attending spectator sports (r = .12), going to the theater (r = .17), going shopping (r = .20), and going dancing (r = .17). Care was negatively associated with attending spectator sports (r = -.13). Fitting in with group was positively related to going to a movie (r = .11) and attending spectator sports (r = .10).

For U.K. clients, the correlation analyses suggested that physical comfort was negatively correlated with playing cards (r = -.22). Ease of dressing was negatively correlated with going to a movie (r = -.47), and attending spectator sports (r = -.37). Fashion was positively correlated to going to a movie (r = .40) and attending spectator sports (r = .30). Fitting in with group was positively correlated with eating out (r = .39), going to a movie (r = .39), attending spectator sports (r = .33), participating in sports (r = .43), going to the theater (r = .28), going shopping (r = .29), and going dancing (r = .28).


Much has been written on the relationship between clothing, self image, and peer group influence (Kaiser, 1990); however, the relationship between rehabilitation clients, CPDV, and social participation has not been explored fully. The primary purposes of this research were: (1) to examine the importance of CPDV, and (2) to explore empirical relationships between CPDV and level of participation in social activities by U.S. and U.K. rehabilitation clients. Although this was an exploratory study, an inference can be made from the statistical results that clothing purchase decision making for rehabilitation clients is a complex process, and some moderate associations exist between 7 CPDV and level of participation in 10 social activities. Caution must be taken not to over generalize the findings with respect to the U.K. clients because of sampling limitations.

The ANOVA results suggested that certain CPDV may have a cultural bias. Type and cost of clothing worn by clients in the U.S. and U.K. could have an impact on clothing decision making. For example, freedom of movement may be more important to U.S. clients because clients in this sample were younger and possibly more active, while fashion may be more important to U.S. clients because they may wear a broader range of clothing items. In addition, care may be less important to U.S. clients because of a less formal life style resulting in a wardrobe dominated by easy-care clothing. Price may be more of an issue for U.K. clients because of higher clothing costs.

As expected, physical comfort was the key determinant in purchasing clothing for both U.S. and U.K. rehabilitation clients; however, physical comfort was found to be negatively related to level of participation in some social activities. From the evidence gathered, the important role clothing plays in the level of social participation of rehabilitation clients was indirectly validated by the correlation analyses. In general, for U.S. clients, the level of participation in some social activities (especially going shopping, eating out, and going to a movie) was negatively tied to the importance placed on physical comfort, freedom of movement, price, ease of dressing and care, and positively tied to fashion and fitting in with group. The level of participation of U.K. clients in certain activities (especially going to a movie and attending spectator sports) was positively tied to clothing that was fashionable and allowed them to fit in with group, and allowed them freedom from concern about physical comfort and ease of dressing. These findings confirmed the importance of wearing a "normative clothing style" for individuals with disabilities (Kaiser et al., 1985) since it facilitated their identification with others and promoted social participation. In other words, these findings suggested that while physical comfort was an important CPDV, fashion and fitting in with group became more important when social interaction was expected. These findings highlighted the need for additional study which will examine the direct causality between clothing and the level of participation in social activities of people with disabilities.

The policy implication of these findings is that the role of clothing in the rehabilitation process needs to be emphasized. Additionally, there is a public mandate for the production and distribution of fashionable and comfortable clothing for people with disabilities (MacDonald et al., 1994). Everyone involved in the rehabilitation process has an important role in carrying out this mandate. Rehabilitation clients must be more forthcoming in terms of demanding fashionable, functional clothing and then channeling the necessary and required information for producing/supplying desirable clothing. Health-service providers must be willing to receive clothing information from all sources and pass it on, not just to clients and their families, but to apparel manufacturers and retailers. In other words, they could help mandate appropriate clothing for their clients from apparel manufacturers and retailers, and they could work with clients and family members to help them make informed decisions. Textile and clothing researchers in the academic setting can contribute in terms of collecting, analyzing, and generating relevant clothing data that would lead to more fashionable and comfortable clothing for rehabilitation clients. The financial support for this mandate should come from both the private and public sectors. Given the large number of potential consumers with disabilities (48.9 million), a market for fashionable and comfortable specialized clothing does exist and awaits new private initiatives. To further entice new apparel manufacturers into the market, federal, state, and local governments could grant fiscal incentives (i.e., a tax-break or subsidy). Even in times of fiscal austerity, many groups compete for limited government expenditures; however, public investment for the rehabilitation of persons with disabilities is still a cost-effective investment for society (Misra, Bua-Iam, & Majumder, 1992).

It is essential to keep in mind that appropriate clothing and social participation by rehabilitation clients should be part of the rehabilitation process in order to achieve full social integration. Since appearance is one aspect of human interaction in social encounters, an increase in the availability of fashionable and comfortable clothing could lead to more rehabilitation clients using clothing as a self-determination tool to increase their level of social participation.


This project was supported in part by the National Institute on Disability and Rehabilitation Research through the West Virginia Rehabilitation Research and Training Center. We gratefully acknowledge the assistance of the following: Dorothy Churchill, Clothing Advisor, Western Wiltshire Disabled Living Center, St. Georges Hospital, Semington, Wiltshire, England, for data collection; Ginny Jenkins, Clothing and Footwear Advisor, Disabled Living Foundation, London, England, for assistance with the questionnaire; Beverly Hummel-Azzaro, Sita Misra, Linda Snyder for comments on a draft of this article; Christine Knabenshue for manuscript preparation; and Gloria Nestor for figure preparation.


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Nora M. MacDonald, West Virginia University, College of Agriculture and Forestry, Divison of Family Resources, 704-N Allen Hall, P.O. Box 6124, Morgantown, West Virginia 26506-6124.